مجله پژوهش در علوم توانبخشی
سال هشتم شماره 2 (خرداد و تیر 1391)

Assessing the abilities of children with cerebral palsy has an important role in planning intervention and providing services by relevant organizations such as Iran’s Welfare Organization. Through classifying hand functions, the Manual Ability Classification System (MACS) helps to achieve this goal. MACS has been recently translated into Farsi but further studies need to be carried out regarding its reliability. Therefore, this study aimed at determining the test-retest and inter-rater reliabilities of the Farsi version of the MACS in children with cerebral palsy (CP). For investigating the reliability of the Persian version of the MACS, inter-rater and test–retest reliability was assessed by comparing ratings of 6 occupational therapists who measured videotaped hand functions of 39 cerebral-palsied Children (23 boys, 16 girls; age range: 4-18 years, mean: 93.12 months) during daily activities. Participants were affected by various types of CP. The intra-class correlation coefficient (ICC) and the weighted kappa coefficient were used for statistical analysis of data using SPSS version 16. Significance level was set at P ≤ 0.05. Findings indicated high inter-rater reliability between 6 occupational therapists so that the first- and the second-round ICC values respectively were 0.96 and 0.95. Weighted kappa coefficient was higher than 0.75, again revealing excellent agreement. With regard to test–retest reliability, the ICC values for occupational therapists were found to be 0.98 and weighted kappa coefficient was 0.75 which showed excellent agreement between raters’ measurements. The Persian version of the MACS has a high test-retest and inter-rater reliability and is seemed to be appropriate for assessing the manual ability of Iranian children with CP

Speech audiometry is one of the most essential components of the current audiologic test battery. It provides information regarding hearing sensitivity and speech intelligibility at supra threshold levels. Considering the importance of the word recognition score (WRS) test and due to the lack of a uniform word recognition list to accomplish that test in Iran, we decided to evaluate people with normal hearing with the four most common lists used for clinical practice in order to select the preeminent one. In this non randomized descriptive-analytic study, thirty normal-hearing adults aged 18 to 40 years were evaluated. Test-retest reliability was achieved within a 2-week interval for the subjects. The subjects’ scores ranged from %92 to %100 when the four lists were considered altogether. The mean scores of word recognition test for each individual list were as follows: list 2: %99/65, list 4: %94/13, list 5: %98, and list 9: %98/53. List 9 was the most reliable one in adults with normal hearing. All the four lists evaluated possess both phonetic and word reliability and the subtle differences between their reliability scores are not statistically significant.

Hemodialysis treatment will affect the patient's life in the long term. The majority of hemodialysis patients lead a sedentary lifestyle which, in return, may cause them additional health complications. The aim of this study was to determine the effect of intradialytic exercise training on the improvement of patients’ quality of lives and muscle strength. The subjects of this experimental study (pretest – posttest with control group) were thirty volunteer patients with the average age of 45 years who were undergoing hemodialysis treatment three times a week at Shariati dialysis center (Isfahan-Iran). All participants were randomly assigned to experimental and control groups. The Quality of Life Questionnaire (KDQOL-SFtm) and a test designed for assessing sitting on and rising from a chair were used for data collection. A five-month exercise training program in which the subject was asked to use a bicycle during dialysis developed for the experimental group. Exercise sessions were held three times a week with the duration of approximately sixty minutes per session. During this period, the control group did not participate in any athletic activity. Descriptive and inferential statistical methods of covariance analysis were conducted for data analysis using SPSS software version 18. The results of this study showed that at the end of the five-month program, the quality of life of the experimental group significantly improved (P < 0.05) while there was not such improvement in the control group (P > 0.05). Moreover, muscle strength had significantly increased in the experimental group as compared to the controls (P < 0.05). Study results indicated that exercise training had a positive effect on enhancing the quality of life, removing fatigue and improving muscle strength in hemodialysis patients. According to the results, the importance of exercise during dialysis to promote physical and mental health in hemodialysis centers becomes obvious.

The purpose of this study was to investigate the effect of mental and physical practice on the learning of rotary pursuit GMP (generalized motor program) and parameter. 20 students of Shahid Beheshti University participated voluntarily in this quasi- experimental study. Having completed the pretest phase, the participants practiced rotary pursuit skill for three days. After 48 hours, they performed the retention test. The data was statistically analyzed via dependent and independent t test (P = 0.05). The results showed that mental and physical practices enhance the learning of rotary pursuit GMP skill and parameter (P = 0.001). It was indicated that there was no significant difference between the mental and the physical practice effects on the learning of rotary pursuit skill GMP and parameter. Mental practice can be an alternative for physical practice in the learning and rehabilitating of GMP and parameter of pursuit skill, especially when an individual isn’t able to use his organ for physical activity and skills performance.

Stuttering is a prevalent communication disorder among children and adolescents. The purpose of this study was to compare the motor speed and lateralization skills of children and adolescents with developmental stuttering with those of their normal counterparts.

In a cross- sectional study, 30 students with developmental stuttering and 30 normal students were recruited from elementary and middle schools of Shahriyar through convenience sampling. A speech-language pathologist confirmed the diagnosis of developmental stuttering in affected subjects. Each group consisted of 26 boys and 4 girls whose average age was 12 years. Finger tapping task as a neuropsychologic test was used for the evaluation. Data were statistically analyzed via dependent and independent t tests using the SPSS statistic software (version 18).

Results showed that there was significant difference between two groups regarding motor speed (P = 0.0001), but, lateralization had a similar pattern in both groups (P = 0.35). Motor speed of the right hand, which is related to the left hemisphere, has a significant predominance to that of the left hand, which is related to the right hemisphere, in both groups. Therefore, the left hemisphere is predominance hemisphere in both groups.

When the production of language is impaired, difficulties are also apparent in motor abilities. In clinical assessment and intervention for stuttering groups should be attended to target motor ability deficits and language impairments simultaneously. It is also possible that atypical lateralization may be the consequence of this disorder rather than being part of its etiology.

One of the most common medical complaints of women is the primary dysmenorrhea or painful menstruation without pathologic pelvic diseases. This study aimed at investigating the effects of Pilate's exercises on the primary dysmenorrhea. Of 1500 female students, 40 non-athlete subjects with the age range of 18 to 25 years who suffered from the primary dysmenorrhea were selected as the sample of this experimental study. These subjects were divided into two groups, namely, the experimental (N = 20) and the control (N = 20) groups. The primary dysmenorrhea questionnaire was administered to satisfy the purpose of the study. The Pilates exercises were carried out under the supervision of a pilates instructor for eight weeks. For the statistical analysis of the obtained data, numerous tests including Sahpiro-Wilk test, the Analysis of Variance (ANOVA) with repeated measurements, and correlated t test were used at the significant level of P ≤ 0.05. The results of this study showed significant improvement in post-treatment pain (P < 0.001) and pain duration (P < 0.001) in the Pilates group. However, no significant difference was found in the degree of bleeding (P = 0.18). Moreover, no significant change regarding these two factors was observed in the control group. On the other hand, a significant difference in pain (P < 0.001) and pain duration (P < 0.001) was found as two groups were compared after the termination of the treatment period. But there was no significant difference in the degree of bleeding (P = 1.00) between two groups. With regard to the specific type of Pilate's exercises, these exercises are likely to be effective in reducing the severity and duration of pain in the primary dysmenorrhea.

Loss of work and barriers to return to work are among the consequences of spinal Cord Injury (SCI). This article will represent some results of a previous study named "Perceived Life Experiences of People with Spinal Cord Injury in the Process of Returning to Work in Qom City". The aim of this latter study was to determine the factors that may facilitate or impede return to work in people with SCI. It was a qualitative study with a phenomenological design. Participants of this study were men with paraplegic SCI who were registered in Qom Welfare Office. Sampling was accomplished through the objective-based method and terminated when sufficient data were obtained. The total number of participants reached to 20 participants who were then placed in two groups consisting of 10 employed and 10 unemployed people each. Data collection was completed via conducting semi-structural interviews and the interpretation of data was made by Van Mennen method. As a whole, 6 central themes representing the experiences of participants were found in this study. According to the analysis of experiences, we found some differences between employment and unemployment participants that illustrated the causes of success or failure in returning to work. In fact incorrect perceive of physical problems, dependent and passive personality, negative attitude to the issues and absences of family support were the special barriers to returning to work in unemployed participants.

Functional ankle instability (FAI) following lateral ankle sprain is a common injury during jumping activities. It has been reported that one of the risk factors of the recurrent ankle sprain is the weakness of the ankle musculature and proximal joints. The aim of this study was to examine the eccentric peak torque of the hip and ankle muscles in athletes with FAI. 30 healthy female athletes with FAI, who were playing volleyball or basketball at league level in Tehran, participated in this study. After conducting and completing clinical examination and related questionnaires, the participants were divided into two groups: the controls and the subjects with functional ankle instability. Speed test for the ratio of eccentric peak torque to the body weight during ankle inversion, ankle aversion, hip abduction and hip adduction movements at 60 and 90 degree/second. Independent t test was administered for the statistical analysis of data using SPSS software, version 13.5 (P ≤ 0.05). The results showed significant difference in the peak torque of eccentric hip abductors in relation to body weight between FAI and healthy groups. The findings of this study showed that the hip abductor weakness may cause FAI. Therefore, athletes with FAI should pay more attention to improve hip abductors in their rehabilitation programs.

Aging process brings about various complications, which affect different aspects of elderly life. The purpose of this study was to study the effect of aquatic exercise on the balance and gait of healthy elderly inactive males. 30 healthy but physically inactive male volunteers, whose age were over 65 years and who had not participated in any exercise program before the initiation of the present study, were randomly assigned into experimental (mean age: 68.53 ± 1.98 years; mean weight: 69.45 ± 2.19 kg; mean height: 168.46 ± 3.08 cm) and control (mean age: 68.66 ± 2.78 years; mean weight: 72.60 ± 3.13 kg; mean height: 170.53 ± 3.14 cm) groups. The experimental group participated in a 6-week exercise program consisting of 3 sessions per week, each last for 60 minutes. Each exercise session included three main phases: a warm up, main exercise program and a cool down. The Sharpened Romberg Test, Star Excursion Balance Test and timed Up and Go were used to measure changes in balance and gait of subjects before the initiation and after the termination of the program. Obtained data were statistically analyzed via ANOVA and mixed multivariate of variance using SPSS software version 16. Significance level was set at P = 0.05. No significant differences observed between pretest and post test scores in the control group (P ≥ 0/05). Significant improvements observed in balance and gait characteristics of the experimental group (P ≤ 0/05). The aquatic exercise program employed in this study resulted in considerable improvements in static and dynamic balance and gait abilities and also in the velocity of healthy elderly inactive men.

Although Parkinson’s disease is categorized under the category of movement disorders, cognitive problems are almost always associated with the disease. The purpose of this study was to compare the cognitive performance of PD patients with that of their healthy counterparts. The montreal cognitive assessment and a demographic questionnaire were administered to 35 PD patients who met the inclusionary criteria. 40 healthy subjects meeting all the inclusion criteria except having Parkinson’s disease were asked to complete the same scales. Correlation coefficient and the analysis of covariance were conducted to analyze the data using SPSS software, version 16. The results showed that the PD patients significantly scored lower than the healthy people in the subscales of visiospatial function, executive function, memory and attention (P < 0.05). Cognitive deficits are among the most common problems occurred in Parkinson’s disease and can be explained through the pathogenesis of the disease. Considering that these kinds of impairment can interfere with the diagnosis, course, prognosis of the disorder and its response to treatment, they must be taken into account when assessing patients.

Lower extremity deformities are associated with various dysfunctions especially during the gait. Despite the fact that genu varum is one of the most common lower extremity abnormalities, it remains unclear what influence this deformity has on one’s functional performance. This study aimed to compare the muscles activity of knee joint muscles in normal subjects and individuals with genu varum during walking and running. In this quasi experimental study, sixteen male subjects aged 15.5 ± 0.6 years were divided into two matched groups, namely, the patients with genu varum and the controls. General and directed co-contraction of knee muscles was evaluated during various phases of walking (loading response and mid stance/propulsion phases) and the stance phase of running. Compared to controls, the subjects in genu varum group displayed greater electromyographic activity of the knee muscles during the loading response phase of walking (%18) and the stance phase of running (%31), but these differences were not statistically significant (P = 0.52 and P = 0.55 respectively). Subjects in genu varum group showed a higher magnitude of directed co-activation of the lateral muscle of knee than medial muscles during the loading response phase of walking and the stance phase of running. In contrast, the control group showed higher magnitude of directed co-activation of the medial muscle of knee. These results demonstrated no significant differences between individuals with genu varum and their control counterparts in the magnitude of muscle co-activation during walking and running. But, it seems that the observed differences in the activation of selected lower extremity muscles between subjects with genu varum and the controls during walking and running may have clinical implications.

The anterior cruciate ligament (ACL) is one of the most important factors in knee stability and motion control so that its injuries result in serious movement problems for patients. The present study clarifies the effect of unilateral ACLT on histological and biomechanical properties of articular cartilage of rabbit knee.

Ten skeletally mature Dutch white male rabbits were divided into 2 groups. In the surgery group, left anterior cruciate ligament was completely transected through midshaft. Histopathological properties, biomechanical charachteristics and thickness of femoral and tibial articular cartilage in left knee measured at 62nd day post surgery. Normal group underwent no intervention in the same period. Biomechanical characteristics of tibial medial plateau and femoral medial condyle studied by means of the ex vivo biphasic stress–relaxation test. Maximal force, elastic modulus, equilibrium force and aggregate modulus were extracted from these data. Data were statistically analyzed via Mann-Whitney U test. To avoid error in histological sample reading, histological study performed on tibial lateral plateau and femoral lateral condyle.

In ACLT group, both femoral and tibial cartilages deteriorated. In comparison to normal group, cartilage thickness in ACLT group decreased significantly only in femoral medial condyle (P = 0.009). All biomechanical parameters of femoral condyle were significantly less than normal group (P < 0.05). The only exception was aggregate modulus that was almost the same in both groups. Biomechanical properties of tibial plateau were not statistically different between the two groups.

Although the structural deterioration of articular cartilage in femoral condyle was less severe than tibial plateau within the first 9 weeks following complete ACLT, functional deterioration was significant only in femoral condyle. However, tibial plateau saved its biomechanical charachtristics despite significant degeneration. The biomechanical and histological alteration of the rabbit articular cartilage described in present study provides further evidence that this small animal model exhibits changes identical to secondary osteoarthritis.

Recently, hydrotherapy has been proposed as one of the newest non-pharmacological methods used in the treatment of osteoarthritis. The aim of the present study was to assess the effectiveness of hydrotherapy and physiotherapy in the functioning, walking and dynamic balance of subjects with knee osteoarthritis. 36 volunteers with knee osteoarthritis were randomly assigned to one of three treatment groups: hydrotherapy, physiotherapy and controls. The subjects in experimental groups received 6 weeks of aquatic therapy and physiotherapy. Step test, timed "Up and Go" Test and Six-Minute Walking Test were used to measure dynamic standing balance, physical function and gait respectively both at pre- and post-test. Data analysis showed that there were not any significant differences between balance, gait and physical function when two groups of physiotherapy and hydrotherapy were compared (P < 0/05). Furthermore, findings showed that both hydrotherapy and physiotherapy treatments increase gait, balance and knee function in the subjects with knee osteoarthritis (P > 0/05). It can be concluded that, despite the effectiveness of the both treatments, there was not any significant difference between the two treatments.

The advantages of participating in physical activities are so well proved that many statements recommend them in preventing chronic diseases such as osteoarthritis. The purpose of this study was to examine the effects of aquatic exercises on the knee pain and its symptoms as well as on the motor performance associated with daily living activities (ADL), sport-recreational activities, and the quality of life of elderly females. 12 elderly women (mean age 52 ± 4.70 yr; mean height 163.17 ± 6.45 cm; mean weight 67.83 ± 6.69 kg) who suffered from knee osteoarthritis participated in the present study. The world-known Knee Injuries and Osteoarthritis Outcome Score questionnaire was used for data collection. Aquatic exercises were carried out under the supervision of an aquatic exercise instructor for eight weeks. The obtained data were statistically analyzed through t test at the significance level of P ≤ 0.05. Knee pain (P = 0.019), motor functions of daily living (P = 0.020), sport and recreation activities (P = 0.003) and subjects’ quality of life (P = 0.048) were significantly improved subsequent to the termination of the training program. However, no significant difference was observed between pre- and post-test conditions concerning symptoms (P = 0.418). The results showed that aquatic exercises, as a safe and effective exercise method, should be incorporated in rehabilitation programs to improve the pain, motor functions and quality of life of elderly females with knee osteoarthritis.

Measuring patellofemoral joint reaction forces (PFJRF) may provide reliable evidence for correcting probable malalignment using patellar taping in subjects with patellofemoral pain syndrome (PFPS). The aim of the present study was to examine the reliability of PFJRF measurements in different patellofemoral conditions during squatting in healthy subjects. PFJRF of eight healthy subjects were assessed using the motion analysis system and the forceplate during single leg squatting. Data were collected from superficial markers taped to the selected landmarks. This procedure was performed on the right knee, before (BT), during (WT) and shortly after removing the patellar taping (SAT). The PFJRF was calculated using a biomechanical model of the patellofemoral joint. There were no significant differences between the PFJRF (mean values ± standard deviation) for the three conditions of BT (2100.55 ± 455.25), WT (2026.20 ± 516.45) and SAT (2055.35 ± 669.30) (P > 0.05). The CV (coefficient of variation), ICC (intra class correlation coefficient), LSD (least significant difference) and SEM (standard error of measurement) values revealed the high reliability of the PFJRF measurements during single leg squatting (P < 0.05). The high reliability of the PFJRF measurements signify that future studies can rely on these measurements during single leg squatting.

Patellofemoral pain syndrome (PFPS) is one of the knee orthopedic disorders which is more prevalent among females and adolescents. Quadriceps weakness, vastus medialis oblique reflex latency, hip abductor and external rotator weakness leading to a wider Q-angle are considered as the main causes of the syndrome. The purpose of the present study was to compare the effects of isolated hip abductor and external rotator strengthening with quadriceps strengthening on the pain and function of female patients with PFPS. 26 females with PFPS were randomly assigned to either group 1 or group 2. Group 1 participated in hip abductor and external rotator strengthening exercises while group 2 underwent quadriceps strengthening 3 sessions a week for 8 weeks. Hand held dynamometer, VAS and WOMAC questionnaires were respectively used to measure the strength, pain and function at pre- and post-intervention. ANOVA with repeated measure was used for the statistical analysis of the data. Both groups showed significant differences between pre- and post-intervention conditions regarding the strength, VAS, and WOMAC values (P ≤ 0.01). Post intervention comparison of VAS and WOMAC values between the two groups did not revealed any statistically significant difference (P ≤ 0.01). Pos- intervention of both groups (1 and 2) showed decreased pain and improved function and strength. However, no significant differences were found between these two groups at post-intervention. Based on the findings of the present study, both hip abductor and external rotator strengthening and quadriceps strengthening improved the pain and the function of patients with PFPS.

Patellofemoral pain syndrome (PFPS) is one of the most common musculoskeletal disorders that results in anterior knee pain and vastus medialis obliqqus (VMO) weakness. The aim of this study was to compare the therapeutic effects of Sweden massage (SM) and strength-stretch exercise (SSE) on PFPS. Thirty-Six male volunteers with PFPS were randomly assigned into three groups: SM group, SSE group, and control. The two experimental groups accomplished their own specific treatment protocols for 8 weeks. Visual analogue scale (VAS) and 6-minute walking test were used before and after interventions to determine the effects of treatment protocols. Both experimental groups showed an improvement in the functional activity and pain reduction; however the SM group had higher significant improvement (P < 0.001). Compared to the control group, the walking distance covered by the subjects of the two aforementioned experimental groups was significantly (P < 0.001) higher following therapeutic interventions, although there was no significant difference (P > 0.05) between them. It can be concluded that SM and SSE may have similar effects on PFPS; however SM method alleviates pain more efficiently.

The aim of the present study was to investigate the effects of sensory and motor cathodal electrical stimulation (ES) on the injury potential, wound closure time and biomechanical properties of acute full-thickness wound in rats. Thirty healthy male Sprague-Dawley rats were randomly assigned to either a control, a sensory [direct current (DC), 600 μA] or a motor (monophasic current, pulse duration 300 μs, 100 Hz, 2.5-3 mA) stimulation group. A 2.5 cm full-thickness skin incision was made on each animal's dorsal region. The stimulation groups received ES for 1 h/day every other day. Wound surface area and differential skin surface potential were measured on the first day and again until the 21st day, every other day. On the 21st day, uniaxial tensile test was carried out and biomechanical properties including stress, strain, E modulus and area under load –deformation curve were measured. Skin potential returned to basal level on the 15th day for the sensory stimulation and control group, and on the 17th day for the motor stimulation group. The wound surface area was closed on the 15th day for the sensory stimulation group whereas this was observed on the 17th day for the motor stimulation and control groups. The motor intensity stimulation could not improve the biomechanical properties of the repaired wound. It seems that the mechanical environment induced by motor intensity of electrical stimulation cannot simulate the role of normal daily stress and strain for the maturation of collagen fibers and their cross links.

In 1991, Dr. David kuehn employed Continuous Positive Air Pressure (CPAP) in treating patients with mild hypernasality whose velopharyngeal gap was less than 2 mm. The purpose of this case report was to represent the results of CPAP therapy on a Persian-speaking patient with minor hyper nasality.

The patient was a 12-year-old male adolescent for whom the main complaint of his family was an indistinct speech and hypernasality which has been aggravated after tonsillectomy. The patient had also received 2 months speech therapy without any noticeable improvement. Having been examined by a speech-language therapist, conducting an endoscopy evaluation was considered to be necessary for the patient. The examination of the patient’s endoscopic images showed that the velopharyngeal gap was less than 2 mm. Movement of the velum and lateral pharyngeal walls seemed to be fairly appropriate and hypernasality was observed to be minor and stable. With respect to his speech and anatomical characteristics, CPAP was decided to be the best treatment option. The patient received 8 weeks of treatment completely according to a prescribed program.

Post-treatment endoscopic examination showed no signs of a gap and the patient’s indistinct and hypernasal speech was completely treated.

If inappropriate learning is the fundamental cause of hypernasality, it is reasonable to assume that some form of information feedback to the individual may influence the treatment of the problem. CPAP can provide a powerful stimulating potential for the adjustment of air pressure in the vocal tract because it has a direct interaction with the positive pressure produced by the respiratory mechanism during speech. Research findings have indicated that during CPAP therapy individuals may achieve better closure of the velopharyngealport in continuous speech due to the training of the velopharyngeal muscles.